Get 09-194 Four Forms.indd - Www2 Binghamton

Filling out the 09-194 Four Forms is essential for providing accurate health information to the University Health Service. This guide will assist you in navigating each section of the form to ensure your information is complete and correct.

Follow the steps to successfully complete the 09-194 Four Forms.

1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
2. Begin by entering your date of entrance into the university, selecting the appropriate semester. Indicate if you have previously attended Binghamton University by checking 'Yes' or 'No', and if 'Yes', write the date of attendance.
3. Provide your BU Student ID number along with your full name including last, first, and middle names. Fill in your birth date as well as your home address and phone numbers.
4. Indicate your full-time or part-time status, and whether you are a freshman, transfer, or graduate student. It is important that you print this information clearly in black ink.
5. Fill out the family history section by providing details about any relevant health conditions that affect your relatives.
6. In the personal history section, carefully answer all questions regarding your health. For any positive answers, provide comments in the designated space below.
7. Complete the meningitis information section by checking the appropriate box based on your immunization status. Remember to sign and date this section.
8. For immunization records, fill in all relevant vaccination dates or provide proof of immunizations. This must be signed by a healthcare provider.
9. Respond to the tuberculosis risk assessment requirements as per the additional form, then provide details regarding your physical examination.
10. Once all the information is complete, review the entire document for accuracy, then save your changes. You can proceed to download, print, or share the completed form as necessary.

Start filling out your forms online today to ensure timely submission!